Cardiovascular Risk Across Myocardial Injury and Infarction Categories Using the Universal Definition: An Individual Patient-Level Data Meta-Analysis.

The goal was to compare the rate and risk of recurrent MI or cardiovascular death among patients with myocardial injury and infarction classified according to the Universal Definition.

该研究的目标是比较根据通用定义分类的心肌损伤和梗死患者中，复发性心肌梗死或心血管死亡的发生率和风险。

Methods

A systematic search of MEDLINE, EMBASE, Central, and Web of Science from January 1, 2007 to July 1, 2025 was performed to identify prospective studies where cardiac troponin was measured for suspected acute coronary syndrome, diagnoses were adjudicated using the Universal Definition, and both MI and cause-specific mortality were reported at a minimum of 1 year.

从2007年1月1日至2025年7月1日，对MEDLINE、EMBASE、CENTRAL和Web of Science进行了系统检索，以识别前瞻性研究，其中对疑似急性冠状动脉综合征的患者进行了心脏肌钙蛋白的测量，诊断使用了通用定义，并且至少在1年后报告了心肌梗死和特定原因的死亡率。

Subdistribution HRs were derived to account for the competing risk of noncardiovascular death.

为了考虑非心血管死亡的竞争风险，得出了亚分布风险比。

Meta-analysiswas performed with random-effects models.

采用随机效应模型进行了荟萃分析。

The primary outcome was major adverse cardiovascular events (MACE), defined as MI or cardiovascular death.

主要结果是重大不良心血管事件（MACE），定义为心肌梗死或心血管死亡。

The secondary outcome was noncardiovascular death.

次要结果为非心血管死亡。

Results

We identified 17 studies of 9 cohorts from 9 countries, with individual patient-level data available in 8 cohorts.

我们确定了来自9个国家的9个队列的17项研究，其中8个队列有个人患者级别的数据可用。

Among 120,734 patients (median age: 61.0 years; 45.8% women), type 1 MI occurred in 9.4% (n = 11,298), type 2 MI in 3.0% (n = 3,609), acute myocardial injury in 4.9% (n = 5,864), and chronic myocardial injury in 4.7% (n = 5,625).

在120,734名患者中（中位年龄：61.0岁；女性占45.8%），9.4%（n = 11,298）发生了1型心肌梗死，3.0%（n = 3,609）发生了2型心肌梗死，4.9%（n = 5,864）发生了急性心肌损伤，以及4.7%（n = 5,625）发生了慢性心肌损伤。

In patients with type 1 and type 2 MI, the MACE rate was 55.2 and 51.7 per 1,000 patient-years and the noncardiovascular death rate was 25.7 and 60.1 per 1,000 patient-years, respectively.

在1型和2型心肌梗死患者中，主要不良心血管事件（MACE）的发生率分别为每1000患者年55.2和51.7，非心血管死亡率分别为每1000患者年25.7和60.1。

Compared with those without myocardial injury, the risk of MACE (subdistribution HR) was 4.82 (95% CI: 3.55-6.57; I2 = 84%) and 3.36 (95% CI: 2.92-3.86; I2 = 0%), respectively.

与没有心肌损伤的患者相比，主要不良心血管事件（MACE）的风险（亚分布风险比）分别为4.82（95%置信区间：3.55-6.57；I2 = 84%）和3.36（95%置信区间：2.92-3.86；I2 = 0%）。

In patients with acute and chronic myocardial injury, the MACE rate was 47.1 and 44.9 per 1,000 patient-years and the noncardiovascular death rate was 67.0 and 46.9 per 1,000 patient-years, respectively.

在急性心肌损伤和慢性心肌损伤的患者中，MACE的发生率分别为每1000患者年47.1和44.9，非心血管死亡率分别为每1000患者年67.0和46.9。

The risk of MACE was 3.24 (95% CI: 2.41-4.36; I2 = 59%) and 3.03 (95% CI: 2.53-3.62; I2 = 20%), respectively.

主要不良心血管事件（MACE）的风险分别为3.24（95%置信区间：2.41-4.36；I2 = 59%）和3.03（95%置信区间：2.53-3.62；I2 = 20%）。

Conclusions

All patients with myocardial injury and infarction are at increased risk of future cardiovascular events.

所有患有心肌损伤和心肌梗死的患者未来发生心血管事件的风险都会增加。

However, in type 2 MI, this apparent risk is reduced by a substantially greater competing risk of noncardiovascular death.

然而，在2型心肌梗死中，这种明显的风险因非心血管死亡的显著竞争风险而降低。

(PROSPERO Registration: CRD42023464836).

(PROSPERO注册号：CRD42023464836)。